| NPI | 1053752352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: IA MD-45270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09800500) |
| 207Q00000X Family Medicine (Licence: IA MD-45270) | |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2020-03-18 |